Many children lately have been suffering from serious diseases, which often have a detrimental effect on their development. A couple of decades ago, few people had heard of such a disease as thrombocytopenia, and now it is more and more often detected in newborns. But what is thrombocytopenia in children, what provokes its development and how does it manifest itself?
Thrombocytopenia in childhood is a pathology during which the level of platelets in the blood decreases, and they, in turn, are responsible for blood clotting. Platelets are blood plates, which, in violation of the integrity of the vessel’s surface, rush to the site of injury and close the wound, stopping the bleeding.
Most often, thrombocytopenia in children is a congenital pathology, for example, in the framework of the syndromes of Bernard-Soulier, Viskota-Aldrich, Fanconi and others. Also in childhood, this disease can be provoked by the enhanced function of the spleen – hypersplenism. And all because of the fact that it is the body where the blood cells that have worked their life are processed.
A decrease in platelet count may indicate that a person has cancer of the blood. When all blood-forming processes in the bone marrow are completely stopped, at the same time the patient has a shortage of other blood components.
The disease is divided into two forms:
- Primary – is accompanied only by the appearance of thrombocytopenic syndrome, while other diseases of the internal organs are absent. Thrombocytopenia purpura, idiopathic and hemolytic uremic syndrome – these are all pathologies of the primary form.
- Secondary is manifested as a complication after the underlying pathology, for example, HIV, liver cirrhosis or leukemia.
Depending on whether the immune component is present in the causes of thrombocytopenia or not, there are two more forms:
- Immune thrombocytopenia – appears during the rapid destruction of platelets under the influence of antibodies. In such a state, a person’s immunity cannot correctly recognize platelets, takes them for a foreign body and produces antibodies against them that block them, thereby aggravating the patient’s already complex condition.
- The non-immune form can develop in the event of mechanical damage to the platelets, this most often occurs in extracorporeal circulation or in the disease Markiafami – Mikeli.
Most often, it is immune thrombocytopenia that occurs in children, and it is divided into several groups.
But what provokes the appearance of the disease, what causes lead to it, except for the hereditary factor?
Most often, thrombocytopenia in children can be triggered by such reasons:
- Insufficient number of trace elements in the body.
- Allergic reaction to products from the outside world.
- Autoimmune process in the body.
- Another pathology, most often it is HIV, liver cirrhosis or leukemia.
But not only diseases and the influence of external factors can cause a disease, it can also be triggered by medications that have been prescribed to the patient.
As practice has shown and numerous studies of scientists, very often thrombocytopenia in young children appears due to the medication of the following groups:
- Antibiotics, most often “chloramphenicol” or sulfonamides.
- Diuretics – Furosemide or Hydrochlorothiazide.
- Anticonvulsant Phenobarbital.
- Antipsychotics – “Prochlorperazine” or “Meprobamate”.
- Antithyroid drugs – “Tiamazole”.
- Drugs against diabetes are Glibenclamide and Glipizide.
- Anti-inflammatory drugs – Indomethacin.
But what symptoms can indicate that the patient has thrombocytopenia?
Thrombocytopenia can manifest itself in each patient differently, the causes and the treatment are thus also individual, but most often the symptoms are very similar in most people:
- Hemorrhages in the skin and mucous membranes. Manifested in the form of small red spots. They are especially noticeable in those places where the clothes most rub against the body. These spots do not cause pain or any discomfort, do not protrude above the surface of the skin or mucous membrane. They can be either point-like or occupy large areas. Bruises of red, blue or even greenish-yellow hue may also appear.
- Frequent bleeding from the nose. The nasal mucosa is abundantly supplied with blood, and a large number of capillaries are present in it. Due to a decrease in platelet formation, capillary fragility increases, so any sneezing, minor injuries or colds can cause bleeding that can last more than 10 minutes.
- Bleeding gums. Many people experience minor bleeding during tooth brushing, but for sick patients this symptom is very pronounced, it develops over a larger area of the gums and lasts long enough.
- Bleeding in the stomach and intestines. They arise because of the fragility of blood vessels, and even eating hard food can provoke them. As a result, blood can go to the feces.
- Blood in the urine. This symptom occurs due to the fact that hemorrhage occurs on the bladder mucosa and on the ways of urine withdrawal.
- Abundant and long periods in girls. In a normal state, the duration of the menstrual cycle is 3-5 days, and during thrombocytopenia, menstruation can last two, or even three times longer, bes >
Do not forget that there may be completely different causes of thrombocytopenia. And each treatment is selected individually. The disease can also manifest symptoms that are characteristic of the pathology that provoked it. During the diagnosis they need to be considered.
If the doctor noticed the patient’s characteristic symptoms of the disease, then first of all he appoints a clinical blood test, with which you can find out the level of platelets in the blood.
Pay attention to the indicators of the number of other bodies – red blood cells and white blood cells.
It is the determination of platelet count that is the main method for diagnosing a disease such as thrombocytopenia in children under one year of age and older.
Currently, all people with HIV are recommended to undergo regular blood tests. Doctors recommend to be examined every six months, and in addition to the general test, others are also tested: for immune status and viral load.
There are 5 main factors that influence the diagnosis:
- The absence of any symptoms in early childhood.
- The absence of symptoms of hereditary forms of thrombocytopenia.
- If there are no clinical manifestations in relatives.
- The effectiveness of the glucocorticosteroid form of treatment in certain dosages.
- If possible, the detection of anti-platelet antibodies.
But how to treat thrombocytopenia in children, which methods are more effective? Traditional medicine can help with such a diagnosis and can it?
Treatment of a patient for thrombocytopenia directly depends on what causes lead to this pathology. Only the correct diagnosis will allow you to choose more effective methods of therapy. Today, doctors use several treatment options:
- Reception of medicines.
- Surgical intervention.
- Treatment with folk methods.
In some cases, it is not necessary to treat the disease, it passes by itself. For example, thrombocytopenia is a secondary mild in children with a slight decrease in platelet count. In such a situation, the doctor can prescribe the patient only the vitamin complex and drugs for general body strengthening.
As for pregnant women in whom this ailment is discovered, then the disease should not cause serious concern.
After childbirth, and in some during pregnancy, the level of these little bodies returns to normal without any treatment. The most dangerous is considered immune thrombocytopenia, it is very important to treat it correctly.
Immune form of the disease is considered one of the most serious, in addition, it is also the most common. Pathology develops against the background of a weakened immunity, caused by the fact that the child has had flu, acute respiratory viral infections, or is an HIV-infected patient. In addition, the reason for the emergence of this form of the disease can become and uncontrolled doctor taking medications.
In cases where thrombocytopenia was caused by a virus or infection, the first thing to do is to cure the disease that caused the platelet count to drop. Perhaps, after therapy, everything will return to normal.
Separate attention deserve HIV-infected patients. So it is just necessary that parents carefully monitor their health and strictly follow all the recommendations of the doctor.
In some cases, in the treatment of thrombocytopenia, surgery is recommended, namely the removal of the spleen. But this method is resorted to only as a last resort, if the patient has a risk of bleeding. As practice has shown, most babies after surgery, if needed, have excellent results.
But not only traditional medicine helps in the treatment, popular methods are also effective.
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To make a diagnosis, you need to undergo an examination that includes such tests:
- general blood analysis;
- Duke test (to determine the duration of bleeding).
If there is a suspicion of hemoblastosis, cancer metastases, Markiafava-Mikeli disease, and B12-deficient anemia, sternal puncture and bone marrow trepanobiopsy are performed.
Additionally, chest x-ray, ultrasound of the spleen or liver, endoscopic examination, an enzyme-linked immunosorbent assay, and a platelet antibody test may be required.
The disease in pediatric patients is detected using:
- visual inspection of the child, as well as an analysis of his complaints;
- general blood test, in which the number of blood plates is determined;
- Duke bleeding duration estimates.
The detection of thrombocytopenia is often random in blood tests.
In some cases, it is advisable to:
- puncture of the spinal cord;
- ultrasound examination;
- antibody test;
- genetic testing, etc.
An important role in examining a small patient is played by the diagnosis of the underlying disease, which contributes to a decrease in platelet count.
Tactics of treatment
Treatment of thrombocytopenia in young patients usually occurs at home for 2 months. Most children do not need drug therapy, even with a severe stage of the disease.
An important step in the treatment of thrombocytopenia is the elimination of the factor that caused the disease
However, if there is a risk of massive bleeding (intracranial or gastrointestinal) or their long duration, it is advisable to use prednisone and intravenous immunoglobulin. It should be borne in mind that the drugs have side effects, often do not lead to complete remission and should be used only under the supervision of a doctor.
In extremely severe cases, the child:
- transfused platelet mass;
- remove the spleen.
In the chronic form of the disease, therapeutic measures are not carried out until massive bleeding occurs.
Sick children should lead a normal life, but undergo routine examinations every six months and avoid bodily harm. Also, contact sports are not recommended for them.
The child needs a complete and balanced diet with the necessary number of micro and macro elements. Coarse and solid foods, as well as cold and hot dishes and drinks should be excluded from the diet.
Over the course of 3 years, most children fully recover. The main thing is to closely monitor the child, follow the doctor’s recommendations and give him your love and affection.
Unambiguously, if the tests showed deviations from the norm, it is worth consulting with a doctor, who will prescribe a comprehensive examination at the first stage. It includes:
- analysis to determine the content of C-reactive protein
- ultrasound of internal organs
- Analysis of urine
- blood tests for iron content.
In some cases, bone marrow puncture may be required. It is a mandatory study for suspected hematologic disease. In this case, the patient is under the close supervision of a doctor. Repeated tests to determine the level of platelets should be taken every 5-7 days.
The causes and treatment of thrombocytopenia in children are directly dependent. Only after conducting a comprehensive examination and determining the true cause of the deviation from the norm, the doctor prescribes treatment.
Symptoms of childhood thrombocytopenia differ from clinical signs in adults. In children, they are characterized by microcirculatory-vascular type of bleeding. In other words, the child has a petechial (point) hemorrhage. On mucous membranes, it can be more significant, for example, gingival bleeding. Hemorrhages in the internal organs in childhood are rare. The most dangerous of them is intracranial.
However, usually thrombocytopenic purpura manifests itself:
- spotted skin rashes
- they do not rise above her
- color from violet to brown (depends on the rate of destruction of hemoglobin)
- ease of rashes with a pluck test
- petechiae can appear on the skin and on the mucous membranes, including and on the conjunctiva.
Shape and variety Group Characterization
Immune, divided into 4 groups
Antibodies enter the body of the child from the mother or are formed during blood transfusions Alloimmune Platelets are affected due to incompatibility of the blood group system or due to the ingress of antibodies to the baby from the parent who is immunized with the antigen. The mother does not have it, but the child has it Transimmune The disease forms in the womb, when the mother’s autologous antibodies cross the placenta to the fetus. Heteroimmune The antigenic composition of platelets changes under the influence of a viral pathogen or against the background of the formation of a new antigen Autoimmune The production of antibodies against their constant antigen A variety that occurs against the background of inhibited proliferation of bone marrow cells Thrombocytopenia consumption resulting from thrombosis and extensive hemorrhage The pathology that forms when bone marrow cells are replaced by neoplasms – these can be cancer metastasis to the bone marrow Pathology resulting from mechanical damage to platelets in the presence of hemangioma Hereditary This form is characterized by inferiority of platelets, as a result of which the life span of the plates is reduced, and the change in their functionality.
Separately, it is worth considering Kazabah-Merritt syndrome and May-Hegglin anomaly. SCM is a rare disease that presents a potential danger to life. With its development, vascular tumors grow to enormous size, combined with a severe form of thrombocytopenia.
For platelets, such a tumor is akin to a trap in which they die, causing impaired blood coagulation. The syndrome manifests itself in babies up to a year old – either immediately after their birth, or in the first months, it is equally inherent in both boys and girls. The prognosis is based on the size of the hemangioma, its location and profuse bleeding.
May-Hegglin anomaly is an autosomal dominant disorder accompanied by thrombocytopenia of varying severity. With its development, bleeding, purpura, and the formation of giant platelets are observed.
Most often, specialists diagnose immune thrombocytopenia, which is divided into:
- Acute, usually manifested in babies aged 2-6 years after the penetration of a viral infection, less often immunization with live vaccines;
- thrombocytopenia of the newborn;
- chronic, more commonly observed in adults and adolescents, while mostly in the female sex;
- drug thrombocytopenia.
Thrombocytopenia is classified according to many signs. According to the etiology of origin, it is primary, or essential (hereditary) and secondary (acquired). In the first case, the disease develops as an independent. In the second embodiment, the cause of the onset is other diseases.
Depending on the pathological factor, there are such varieties of thrombocytopenia:
- insufficient platelet formation;
- platelet destruction.
The latter species has 2 groups: non-immune and immune (iso-, trans-, hetero- and autoimmune).
Depending on the course, 2 forms of thrombocytopenia are distinguished:
- Sharp. It can last up to 6 months, characterized by an acute onset and a rapid course.
- Chronic Duration of more than 6 months, platelet count may either decrease or approach normal.
The latter form is more difficult to treat.
Signs and symptoms of the disease
Whatever factor triggers a decrease in blood cell volume, the disease is accompanied by a number of non-specific symptoms:
- There is bleeding of the oral mucous layer, frequent nosebleeds, occurring in 20-30%.
- Bruises suddenly and unreasonably appear on the body and limbs, scratches and injection sites bleed for a long time.
- A small red rash appears on the legs and other parts of the body.
- Internal bleeding appears.
- Stopping blood loss is noticeably difficult.
- Blood clots are rare in bowel movements.
How to treat a disease
If there is hemorrhagic syndrome, bleeding, rashes on the mucous layers, areas of the face, a rapid decrease in the number of platelets, prescribe treatment with steroid drugs, for example, Prednisolone. A positive effect in most cases is noted on the first day of therapy, after a week or 10 days, the rashes disappear.
To help drugs, traditional medicine can be connected. But prescriptions of healers – and especially with pathology in an infant, must be approved by the attending physician. When cooking, it is necessary to strictly adhere to the indicated dosages and take into account the possibility of individual intolerance to plant components.
Alternative treatment involves the use of herbs whose action is aimed at improving blood coagulation.
These include nettle and dogrose, yarrow and others:
- To prepare a decoction of nettle leaves in 200 ml of boiled liquid, three large spoons of the crushed ingredient are steamed. The tool is insisted for 10 minutes, filtered. The cooled drink should be taken three times a day.
- Two large spoons of crushed yarrow are brewed in 200 ml of boiling liquid, the product is insisted for half an hour, filtered, taken three times a day. A single dose is one large spoon.
- A large spoonful of wild strawberry berries is mixed with the same number of rosehip berries, 200 ml of boiled liquid are poured into the fruit, the remedy is insisted for 15 minutes, filtered, ½ cup is drunk three times a day.
- Sesame oil helps to regulate the platelet count – in the mornings and evenings it is recommended to add 10 ml of the product to the food.
- A mixture of three walnuts with a small spoon of natural honey increases daily hemoglobin.
Features of food
There is no special diet for children, adolescents and adults in the formation of the disease, but it is proposed to focus on the following statement – the body needs a nutritious food, including the right amount of protein, vitamins, and trace elements.
The menu should be gentle, with the inclusion of products that increase blood thinning. The features of nutrition include the need to exclude sharp and very hot dishes in order to avoid burns of the mucous membranes. When choosing dishes, preference is given to:
- Buckwheat porridge, oatmeal and sprouted wheat;
- various nuts;
- beef liver;
- natural juices – strawberry, strawberry, raspberry;
- bananas and various greens.
If bleeding gums is observed, it is recommended to chew currant and blackberry fruits, drink teas from their leaves, twigs. A positive effect will be the use of products containing B12 and folic acid – melons, beans, avocados, apricots.
Thrombocytopenia is not an indication for dietary nutrition, but the diet is still worth reviewing. You can not additionally expose the body to stress, so spicy and too hot food, fast food, convenience foods, smoked meats, products containing dyes and preservatives, alcohol are excluded from the menu. They irritate the mucous membrane of the digestive tract, therefore, increase the likelihood of gastrointestinal bleeding. Food with thrombocytopenia should be as gentle as possible.
In no case should you eat blood thinning food. These are tomatoes, mushrooms, cranberries, viburnum, olive and linseed oil, citrus fruits and other foods high in vitamin C.
The diet for thrombocytopenia involves eating only wholesome foods that are high in vitamins and trace elements. With iron deficiency anemia, it is worthwhile to include in the diet products that increase hemoglobin. This is buckwheat, beef liver, nuts, oat, corn and barley groats. With a lack of vitamin B12, you need to eat legumes, apricots, peaches, melons.
It is worth consuming freshly squeezed fruit and vegetable juices daily (apple, banana, beetroot, cabbage, black radish), it is useful to drink tea from mountain ash, twigs of currant, raspberry, strawberry, blackberry and strawberry compote.
To reduce bleeding, you can take a decoction of nettles, with the addition of yarrow, rowan fruits, rose hips, strawberries, chicory and water pepper.
Thrombocytopenia in children in a mild form can only be treated with a diet. Medicines are not used. More severe forms require complex treatment.
As for the preventive measures of thrombocytopenia, a specialist should deal with their determination. Most often, to keep platelets in balance, it is recommended:
- The prohibition of vaccinations, in case of urgent need, the introduction of drugs is carried out in a hospital.
- To stop taking anticoagulants and antiplatelet drugs.
- Exclude surgery, intravenous injection.
Parents should exclude exposure to a child of various allergens, to minimize the risk of injuries. Accordingly excluded sports, outdoor activities. It is necessary to protect children from infectious pathologies, colds, tell them about the characteristics of the body.
Unfortunately, preventive measures of primary thrombocytopenia in infants do not exist.
Prevention of acquired forms is a healthy lifestyle, proper nutrition, avoiding stress and excessive physical exertion, healthy sleep. It is important to walk in the fresh air every day, to strengthen immunity, so that you get less sick from viral diseases.
The prognosis in most cases is favorable. If thrombocytopenia in children is diagnosed in a timely manner, then in 75% of cases, treatment is effective. But after therapy, you need to be observed by a doctor, there is a risk of relapse.
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